Patient with a history of kidney transplant s/p biopsy 2 weeks prior now undergoing chemotherapy treatment for leukemia develops acute abdominal pain, worsening renal function and hypertension.
Renal US followed by CT are shown below:
|Renal US with dopplers|
|Renal US longitudinal view|
|Abdominal CT with renal tx on right lower quadrant|
|Abdominal CT with red-marked kidney parenchyma|
Diagnosis: Page kidney is a condition where extrinsic renal compression from a haematoma or mass results in hypertension and loss of renal function. This condition was initially described by Irwin Page in an animal model with cellophane papers wrapped around the kidney in 1939 and, subsequently, clinically in 1955.Most cases are caused by a subcapsular haematoma following blunt trauma or invasive procedures (eg. renal biopsy). Few cases of spontaneous hematoma have also been reported. Acute renal failure is due to a decreased perfusion of the compressed kidney as a result of pressure exerted by the subcapsular haematoma. In our case, the drop in platelets (4,000) after chemotherapy might have precipitated the bleeding from the previously biopsied site.
Treatment involves relief of the pressure and restoration of blood flow by percutaneous drainage. Nephrectomy is recommended in cases not resolved by interventional nephrology. Conservative course (observation and medical management) has been performed in some case reports.